Healthcare Provider Details

I. General information

NPI: 1598825689
Provider Name (Legal Business Name): SUZANNE WERTMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 S 17TH ST
WILMINGTON NC
28401-6444
US

IV. Provider business mailing address

2104 METTS AVE
WILMINGTON NC
28403-2248
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-1031
  • Fax: 910-251-8896
Mailing address:
  • Phone: 910-632-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number373
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: